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Date: 


Location:  

Camper Registration, Medical Release & Risk Assumption Form

Please download form to your computer; complete form; return it to FBC of Enumclaw, 3466 Porter Street, Enumclaw, WA 98022:

CAMPER INFORMATION:

Name:_____________________________________ Age:____ Birth Date:___/___/___ 

Address:__________________________City:__________________ State:__________

Zip:_________________  Phone #:___________________ Email:_________________

Gender:  male  /   female  (circle one)

CHURCH INFORMATION:  (Are you currently affiliated with a church?  If so......)

Your Church Name:______________________________________________________

Address:________________________City:_______________State:_____ Zip:_________

PARENTAL INFORMATION:

Parent/Guardian:___________________________________________________________

Address:_________________________City:_____________State:______ Zip:_________

Home #:___________________ Work #:__________________ Cell #:_______________

EMERGENCY CONTACT (if different from Parental Information):

Name:_______________________________ Relationship:_______________________

Home #:________________ Work #:_________________ Cell #:___________________

MEDICAL INFORMATION:

Is your child taking any medications:________________________________________

Can your child be given Tylenol:   Yes or No? (circle one)

If no Tylenol then what is preferred:_______________________________________

Does your child suffer w/allergies:_____________________________

Does your child have any food allergies:____________________________

Medical Insurance Company:________________________ Policy #:_________________

SPORTS SELECTION:



ATTENTION PARENTS:  Children MUST have completed Kindergarten (entering 1st grade) in order to register.

Children who have NOT completed 2nd grade will be assigned to 'Little Tykes' that will include introductory sports training including several sport opportunities.   If your child has NOT completed 2nd grade write "Little Tykes" as their first and second choice.





Children who HAVE completed 2nd grade may choose from the following sports:  Football; Soccer; Cheerleading; Basketball; Volleyball; Baseball

First Choice:____________________  Second Choice:______________________

Has your child attended Sports Camp before?  Yes or No  (circle one)

Has your child participated in the above chosen sports before? Yes or No (circle one)  

How many years have they participated in the above chosen sports? ________

WAIVER AND RELEASE:

I hereby grant permission for my child to attend the GNM Sports Camp to be held at

I hereby waive and release First Baptist Church of Enumclaw and Good News Ministries (sponsors) from liability of any nature, including but not limited to injury, damage or other misfortune resulting during Sports Camp activities.

I am fully aware that there is an element of risk of injury, damage or other misfortune associated with the GNM Sports Camp activities that will be taking place at the GNM Sports Camp and First Baptist Church of Enumclaw.  I accept the risk of such activities, and undertake them voluntarily. 

In consideration of the permission to participate extended to me and for the opportunity rendered by First Baptist Church of Enumclaw, I do hereby for myself, heirs, personal representatives and agents forever release and discharge any claims, demands, actions or lawsuits that may occur, which in any manner involve the parties listed above in paragraph one, as a result of negligent, but not reckless or intentional conduct during participation of the above.

Signature of legal guardian:__________________________Date:_________________

Do you hereby release any and/or all rights to photos taken of you or those listed above for future use by First Baptist Church of Enumclaw and Good News Ministries, GNM Sports Camp, its staff, founders, and/or Board of Directors in event and rally publications, videos, books, newsletters, etc?  Yes_____ No______ (please initial yes or no)

 
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